This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. An expressive writing (EW) intervention in which individuals write about traumatic, stressful events, has been shown to produce improvements in medical and emotional outcomes for healthy and chronically ill adults. Given the high rate of depression in individuals with diabetes, and the relationship between stress and blood glucose control, diabetes may be responsive to EW. Pilot studies demonstrated that EW is acceptable and feasible for adults with type 2 diabetes. This NIH-funded study is an extension of several pilot studies using additional measures and modifing the intervention. It will be carried out at three sites (Syracuse, Penn State and Vanderbilt Universities) at which a total of 300 patients with diabetes will be randomly assigned to one of three groups. One group (control) will participate in a neutral writing exercise and neutral "booster" writing sessions every 4 months for a period of 2 years. Two groups will participate in an EW exercise (writing for 3 sessions about traumatic or stressful events in their lives);one of these two groups will receive 5 booster sessions of additional EW, while the other will receive booster sessions of neutral writing, at 4 month intervals. All participants will complete measures of disease status, quality of life, and psychological status every 4 months for a period of 2 years. The overall aim is to see if the experience of EW results in improvements in medical and psychosocial outcomes, how long these improvements last, and whether adding booster sessions leads to greater or more lasting improvement.